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Talini C, Carvalho ARDAS, Viera CS. Elective pediatric surgery: profile description of children and late referral identification. Rev Col Bras Cir 2023; 50:e20233516. [PMID: 37341289 PMCID: PMC10508650 DOI: 10.1590/0100-6991e-20233516-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/02/2023] [Indexed: 06/22/2023] Open
Abstract
Pediatric surgery receives great demand for referrals from primary care services in order to evaluate the need for surgical intervention. However access to this specialized evaluation and in intervention does not always occur at the appropriate time. This study aims to characterize the profile of pediatric patients electively operated in the western Paraná state region, between 2018 and 2020, and identify those who were lately referred to surgical evaluation. This is a descriptive, cross-sectional and retrospective study through the review of electronic medical records. The variables evaluated were sociodemographic data, information on underlying diseases, referral data, specialist assessment and surgical procedure. During this period, 410 patients underwent an elective surgical procedure, of which 289 were included in the research. The sample was predominantly male (72.3%) with a mean age of 57.9 months at the surgeons assessment and 59 months at the date of surgery. Most of the patients came from primary care (75%) and the most common pathology was inguinal hernia (39.1%). The mean time interval between referral through primary care and surgery was 4.98 months, and between the surgeons assessment and surgery was 1.21 months. Of the total sample, 77 (26.6%) patients were identified as being referred late for the surgical procedure. Knowing the profile of patients and the problems experienced in this region in relation to the care provided in pediatric surgery provides subsidies to propose improvement strategies not only for the health system in this location, but for several inner regions of Brazil in a similar situation.
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Affiliation(s)
- Carolina Talini
- - Universidade Estadual do Oeste do Paraná, Programa de Pós-graduação em Biociências & Saúde - Cascavel - PR - Brasil
| | | | - Claudia Silveira Viera
- - Universidade Estadual do Oeste do Paraná, Programa de Pós-graduação em Biociências & Saúde - Cascavel - PR - Brasil
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Family planning and parity among pediatric surgeons — it is time to confront a serious problem (a survey among Brazilian female pediatric surgeons). ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obstetric problems and infertility affect female surgeons. Family perspectives influence specialty choice and attrition rates. We aim to study parity, fertility, and family planning among female pediatric surgeons. A questionnaire was filled out by licensed BFPS to evaluate pregnancy/motherhood among Brazilian female pediatric surgeons (BFPS). The professionals were divided into two groups that were compared (< 40 and ≥ 40 years of age).
Results
Eighty-three < 40 and 91 ≥ 40-year-old BFPS were included, of which 2/3 were mothers. Most planned children after being hired as consultants. Almost a tenth (8.87%) reported marital conflicts secondary to the refusal to get pregnant. A fifth reported a high-risk pregnancy, and 12.73% had miscarriages. Half reported no adverse consequences of postponing pregnancy, but 6.9% stayed childless, 16.67% had fewer children than planned, and 10.92% needed infertility treatment. Professional problems related to pregnancy/motherhood were reported by 59.09%, and 86.36% of the women who were mothers had difficulties conciliating professional duties and motherhood.
Conclusion
BFPS parity was 1.38, lower than Brazilian women (mean 1.77 children/woman). Most BFPS start their families by late 30s or early 40s. Unfavorable consequences of postponing pregnancy affected a third of BFPS. Time off after pregnancy and protection during pregnancy remain problematic. A hostile environment and life-career conflicts may lead to the abandonment of the specialty.
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Maia VO, Pavarino E, Guidio LT, de Souza JPD, Ruano R, Schmidt AF, Fabbro ALD, Sbragia L. Crossing birth and mortality data as a clue for prevalence of congenital diaphragmatic hernia in Sao Paulo State: A cross sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100328. [PMID: 36777389 PMCID: PMC9903978 DOI: 10.1016/j.lana.2022.100328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Congenital diaphragmatic hernia (CDH) is a severe embryological defect that causes pulmonary hypoplasia and hypertension. The prevalence and mortality rate of CDH varies around the world and little information is available about CDH in Latin America. Our aim was to estimate the general prevalence, mortality rate, prevalence of associated anomalies and features related to the outcomes of CDH in newborns from São Paulo state, Brazil. Methods Population-based cross-sectional study based on data gathered from the Live Births Information System (SINASC) and the Mortality Information System (SIM) of children born in São Paulo state between January 1st, 2006, and December 31st, 2017. Findings From 7,311,074 total survival discharges between 2006 and 2017, 1,155 were CDH-related, resulting in a prevalence rate of 1:6329 (95%CI = 1/6715 - 1/5984) and a mortality rate of 63·72% (95%CI = 60.95 - 66.50), 510 presented complex associated anomalies (44·15%). Maternal data showed higher prevalence among older mothers (older than 35 years old: 2·13 per 10,000) and, also, women with more years of schooling (higher than 12 years: 1·99 per 10,000). Presence of associated anomalies (95%CI = 5.69-11.10), 1-min Apgar (95%CI = 1.44-2.95), maternal schooling (95%CI = 1.06-2.43) and birth weight (95%CI = 1.04-2.26) were the most significant features associated with mortality. Interpretation There was 1 CDH case for every 6329 newborns in São Paulo and the mortality rate among those cases was 63·72% - a high rate compared to other countries. Funding This study didn't receive any specific grant from any funding agency in the public, commercial or not-for-profit sectors.
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Affiliation(s)
- Victoria Oliveira Maia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Pavarino
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Leandro Tonderys Guidio
- Medical School of Bauru, School of Dentistry, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - João Paulo Dias de Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Ruano
- Department of Pediatrics and Department of Obstetrics, Gynecology and Reproductive Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Augusto Frederico Schmidt
- Department of Pediatrics and Department of Obstetrics, Gynecology and Reproductive Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amaury Lelis Dal Fabbro
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Lourenço Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil,Corresponding author at: Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo. Av. Bandeirantes 3900 - Monte Alegre, Ribeirão Preto, SP Zipcode: 14049-900, Brazil.
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Vasques MCMZ, Silva BB, de Avila MAG. Construction and validation of a Brazilian educational comic book for pediatric perioperative care. J SPEC PEDIATR NURS 2021; 26:e12320. [PMID: 33207037 DOI: 10.1111/jspn.12320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/16/2020] [Accepted: 10/20/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Educational material can facilitate familiarization with the hospital and surgical contexts for children and guardians and minimize potential difficulties experienced during hospitalization. This study aimed to construct and validate a comic book for guiding children in perioperative care. DESIGN AND METHODS A descriptive study was conducted at a pediatric ward in a university hospital in Brazil. A content validity index with a concordance of 0.8 was used for validation. RESULTS The content was validated with the participation of 19 content judges (nurses, anesthesiologists, and surgeons); face validity was achieved with the participation of 22 parents and their respective children aged 7-12 years old. The contents of the comic book included perioperative care (hospitalization, fasting, surgical team, operating room, and anesthesia). Universal content validity indices of 0.89 and 0.99 were obtained for content and face validity, respectively. Free Portuguese educational material titled "Getting to know the Surgery Center" was created in the form of a 19-page comic book in print and digital formats. The comic book was face and content validated and considered relevant for children in perioperative care. The suggestions of the healthcare professional and families who participated contributed toward the final version of this educational comic book. PRACTICE IMPLICATIONS This study aimed to further the development of educational materials that help alleviate stress, fear, and anxiety among children awaiting surgery, as well as their parents/guardians. As such, it offers a positive and appropriate contribution to perioperative nursing. The study further contributes to a discussion on pediatric nursing, which goes beyond clinical care and procedure. In the context of pediatric surgery and the children themselves, the results indicate that the family must be included in the surgical process and that the language employed must be appropriate to the target audience. Our comic book can be used by nurses to develop similar resources for diverse needs.
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Affiliation(s)
- Marcela C M Z Vasques
- Department of Nursing, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
| | - Brenda B Silva
- Department of Nursing, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
| | - Marla A G de Avila
- Department of Nursing, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
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Oliveira APCD, Gabriel M, Poz MRD, Dussault G. Challenges for ensuring availability and accessibility toin health care services under Brazil's Unified Health System (SUS). CIENCIA & SAUDE COLETIVA 2018; 22:2397-2424. [PMID: 28444043 DOI: 10.1590/1413-81232017224.31382016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/21/2016] [Indexed: 11/21/2022] Open
Abstract
Shortages and imbalances in the distribution of the health workforce, are social and political problems that, along with the socio-economic inequality, reduce the access of the population to the health services. This study aims to understand the challenges of SUS policy-makers and managers to ensure the availability and geographical accessibility to health service providers. The analysis was guided by a framework of the health labour market and health policy interventions. Two main problems have been identified: shortage of doctors and maldistribution of professionals between levels of health care and between geographical areas. This review focused on eight interventions in the last 30 years, whose mainly aim was to correct the maldistribution of physicians in the SUS such as Rondon Project, Interiorization of Health Work Program, Medical Specialists Training Program, PHC Program and More Doctors Program. The discussion focuses on the factors that influence the outcome of these interventions.
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Affiliation(s)
- Ana Paula Cavalcante de Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa. R. da Junqueira 100. 1349-008 Lisboa Portugal.
| | - Mariana Gabriel
- Departamento de Odontologia Social, Faculdade de Odontologia, Universidade de São Paulo. São Paulo SP Brasil
| | - Mario Roberto Dal Poz
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa. R. da Junqueira 100. 1349-008 Lisboa Portugal.
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Franzoi MAH, Goulart CB, Lara EO, Martins G. Music listening for anxiety relief in children in the preoperative period: a randomized clinical trial. Rev Lat Am Enfermagem 2016; 24:e2841. [PMID: 27992027 PMCID: PMC5171712 DOI: 10.1590/1518-8345.1121.2841] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/23/2016] [Indexed: 11/22/2022] Open
Abstract
Objective to investigate the effects of music listening, for 15 minutes, on the preoperative anxiety levels in children undergoing elective surgery in comparison with conventional pediatric surgical care. Method randomized controlled clinical trial pilot study with 52 children in the preoperative period, aged 3 to 12 years, undergoing elective surgery and randomly allocated in the experimental group (n = 26) and control group (n = 26). Anxiety was assessed in both groups by the application of the modified Yale Preoperative Anxiety Scale and measurement of the physiological variables, upon arrival and 15 minutes after the first measurement. Results there was a statistically significant difference in preoperative anxiety between the two groups only in relation to the physiological variable, since the respiratory rate of preschool children in the experimental group reduced in the second measurement compared to the control group (p = 0.0453). The experimental group showed a statistically significant reduction in anxiety levels after 15 minutes of music listening (p = 0.0441), specifically with regard to the behavioral domains of activity, vocalization, emotional expression and apparent awakening state. Conclusion music listening emerges as a potential nursing intervention for relief of preoperative anxiety in children undergoing surgical procedures. RBR-7mcr59.
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Affiliation(s)
| | | | | | - Gisele Martins
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade de Brasília, Brasília, DF, Brazil
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Hoyler M, Finlayson SRG, McClain CD, Meara JG, Hagander L. Shortage of Doctors, Shortage of Data: A Review of the Global Surgery, Obstetrics, and Anesthesia Workforce Literature. World J Surg 2013; 38:269-80. [DOI: 10.1007/s00268-013-2324-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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